Basic Information
| Provider Information | |||||||||
| NPI: | 1124458310 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADE KIDNEY SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | CASCADE KIDNEY SPECIALISTS | ||||||||
| Address2: | 1370 116TH AVE NE SUITE 209 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254538406 | ||||||||
| FaxNumber: | 4254534173 | ||||||||
| Practice Location | |||||||||
| Address1: | CASCADE KIDNEY SPECIALISTS | ||||||||
| Address2: | 1370 116TH AVE NE SUITE 209 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254538406 | ||||||||
| FaxNumber: | 4254534173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2013 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | KANDALA | ||||||||
| AuthorizedOfficialFirstName: | MADHURI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4254538406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.